Some reflections on teaching the sociology of health and illness and the internalization of neo-liberal discourse

Over the previous eight weeks I have written a series of posts based on lectures I have delivered as part of a module which was designed in order to introduce the sociology of health and illness to first year undergraduates on non-sociology degree programs. In this final post in this series I will reflect on the previous posts and some of the interactions I had with students over the course of the module.

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In the first post I suggested that there are two central targets of sociological analysis which can offer something to an understanding of health and illness; social structures and experiences.

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Analysis of social structures is useful because it can demonstrate to us how ‘social things‘ are ‘made up’ by social interactions but have a high level of solidity and influence over our lives. We can, therefore, explain patterns of illness through understanding the different social pressures faced by particular social groups. These pressures and influences cannot be explained through biology or psychology, yet they may have have impacts on the biology or psychology of the individual.

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The study of experiences can show us what it is like to have cancer or arthritis and how the symptoms of these conditions impact on the identity of people. If people are to be treated for such conditions it is crucial that the reality of everyday life is taken into account to be aware of what difficulties might be faced. Similarly, if people are expected to change their lifestyle in order to reduce their risk of developing illnesses how the meaning of their everyday eating, drinking and exercise behaviours and how these relate to their sense of self must be taken into consideration.

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Seven topics were used to explore the sociology of health and illness which intersected with social structures and experiences in a variety of different ways. Social structures were explored for the ways in which they can help to produce and reproduce health inequalities which were also addressed through the notion of capitalism and its role in generating different class groups and broader social and economic inequalities.

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The importance of understanding experiences was introduced through discussing the approach to analysing ‘illness narratives‘ which can highlight how health conditions can impact on the pictures people hold of themselves, their lives and their futures. Understanding experiences is also vital in order to get a full picture of how ethnicity and health relate to one another as cultures which are built around particular ethnicities can be particularly powerful and have a strong influence on health practices. Similarly, the importance of gender for understanding how health is experienced and inequalities are produced was explored.

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The ways in which people experience health and illness were shown to intersect with the structures of the scientific and medical disciplines through the increasing influence of medical and rational knowledge and practices on our lives.

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If I were to try to distil the message of the module down to one insight it would be that our individual behaviours and interpretations of ourselves and the world are heavily influenced (although not entirely determined) by the social context in which we find ourselves. It is my opinion that this is a particularly important insight today because of the ongoing destruction of a social safety net in the form of the austerity measures which are drastically decreasing health and social care provision. This has been partly justified through a greater political emphasis being placed on individual responsibility for health and social problems.

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Throughout the module I discussed with students the issue of to what extent individuals can be considered to be responsible for their own health in relation to “lifestyle” related conditions. Most students developed a very good understanding of some of the fundamental aspects of how social factors cause health inequalities but almost all concluded that “ultimately” the individual is responsible, it is them that must make the changes to their lives.

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I found this interesting both as a teaching challenge and as an ontological issue. It posed no issue for the students to have a fairly sophisticated understanding of the existence of social patterns of health and illness and how social structures can act as “fundamental causes” of illness yet maintain that really the individual, and only them, can change their own situation.

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During teaching on the module I used the article written by Marian Peacock, Paul Bissell and Jenny Owen (I also discussed this here) which drew on in-depth interviews with people diagnosed with obesity to analyse how neo-liberal discourses of individual responsibility had been internalized by people in this situation. It struck me that a similar situation was at work here. Many of their respondents also acknowledged that some structural issues had an impact on them (sometimes discussed in terms of childhoood or upbringing) yet maintained that they were themselves ultimately responsible for their situation.

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Many of the students on my module will go on to work as health professionals of various kinds and I hope will be able to take some of the things I have discussed with them through into their practice but I feel that this might be very difficult for them. Not only will they be faced with a professional and political system which puts the overwhelming emphasis on individual responsibility but many of them have internalized the notion that it is interesting to understand social structures and processes but they are, at best, of secondary significance to behaviour change.

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This is an issue which students raised. They seemed find sociological insights interesting but could not see how they could be applied to their task of changing behaviour. I suggested that if we accept that social factors play a role in health outcomes we cannot just target individual behaviours so I proposed two ways they could take these insights forwards (if anyone else has any thoughts in this area I would love to hear them):

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Individuals are more able to change their behaviour if they better understand how social factors affect them.

Professionals can target social factors in their interventions (but might need to think outside of their usual remit), they could: